Healthcare Provider Details

I. General information

NPI: 1902303100
Provider Name (Legal Business Name): MIRIAM DEBORA FERGUSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRIAM DEBORA VOLOSEN

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 FANNIN ST STE B452
HOUSTON TX
77030-2703
US

IV. Provider business mailing address

6565 FANNIN ST STE B452
HOUSTON TX
77030-2703
US

V. Phone/Fax

Practice location:
  • Phone: 713-441-3620
  • Fax: 713-790-2082
Mailing address:
  • Phone: 713-441-3620
  • Fax: 713-790-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberU3208
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberU3208
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: